Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study.

PURPOSE: Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE). METHODS: A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores). RESULTS: Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses. CONCLUSION: In hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating. GOV ID: NCT04377035.

Echocardiographic abnormalities and predictors of mortality in hospitalized COVID-19 patients: the ECHOVID-19 study.

AIMS: The present study had two aims: (i) compare echocardiographic parameters in COVID-19 patients with matched controls and (2) assess the prognostic value of measures of left (LV) and right ventricular (RV) function in relation to COVID-19 related death. METHODS AND RESULTS: In this prospective multicentre cohort study, 214 consecutive hospitalized COVID-19 patients underwent an echocardiographic examination (by pre-determined research protocol). All participants were successfully matched 1:1 with controls from the general population on age, sex, and hypertension. Mean age of the study sample was 69 years, and 55% were male participants. LV and RV systolic function was significantly reduced in COVID-19 cases as assessed by global longitudinal strain (GLS) (16.4% ± 4.3 vs. 18.5% ± 3.0, P < 0.001), tricuspid annular plane systolic excursion (TAPSE) (2.0 ± 0.4 vs. 2.6 ± 0.5, P < 0.001), and RV strain (19.8 ± 5.9 vs. 24.2 ± 6.5, P = 0.004). All parameters remained significantly reduced after adjusting for important cardiac risk factors. During follow-up (median: 40 days), 25 COVID-19 cases died. In multivariable Cox regression reduced TAPSE [hazard ratio (HR) = 1.18, 95% confidence interval (CI) [1.07-1.31], P = 0.002, per 1 mm decrease], RV strain (HR = 1.64, 95%CI[1.02;2.66], P = 0.043, per 1% decrease) and GLS (HR = 1.20, 95%CI[1.07-1.35], P = 0.002, per 1% decrease) were significantly associated with COVID-19-related death. TAPSE and GLS remained significantly associated with the outcome after restricting the analysis to patients without prevalent heart disease. CONCLUSIONS: RV and LV function are significantly impaired in hospitalized COVID-19 patients compared with matched controls. Furthermore, reduced TAPSE and GLS are independently associated with COVID-19-related death.

Organochlorine pesticides in the indoor air of a theatre and museum in the Czech Republic: Inhalation exposure and cancer risk.

Organochlorine pesticides (OCPs) have been used to preserve the integrity of historical buildings or to protect collections of artefacts at potentially large volumes and often without detailed application records. Previous research has focused on the efficiency of remediation at contaminated sites (where identified), as well as improvement of preservation techniques and workplace health and safety. Few studies have assessed the human health risks from occupational exposure to OCPs in buildings of cultural and historical importance. Thus, potential risks may remain unidentified. In the present study, OCPs in indoor air were measured in a baroque theatre and a natural history museum in the Czech Republic, both of which had suspected past indoor application. In the theatre attic p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) levels in air were up to 190ngm-3, confirming past indoor use of p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT). There was also evidence of γ-hexachlorocyclohexane (γ-HCH) use in the theatre (max γ-HCH in air of 56ngm-3). Yet, the cancer risk (CR) from occupational exposure via inhalation (Expi) to OCPs in the theatre was low (CR<4.0×10-6). γ-HCH was found at elevated levels in air of the museum (max γ-HCH in air of 15,000ngm-3). CR from Expi in the museum was moderate to high (>1×10-4). Our results show the CR through Expi to OCPs in buildings, such as museums can still be significant enough to warrant mitigation measures, e.g., remediation.

Using long-term air monitoring of semi-volatile organic compounds to evaluate the uncertainty in polyurethane-disk passive sampler-derived air concentrations.

Much effort has been made to standardise sampling procedures, laboratory analysis, data analysis, etc. for semi volatile organic contaminants (SVOCs). Yet there are some unresolved issues in regards to comparing measurements from one of the most commonly used passive samplers (PAS), the polyurethane foam (PUF) disk PAS (PUF-PAS), between monitoring networks or different studies. One such issue is that there is no universal means to derive a sampling rate (Rs) or to calculate air concentrations (Cair) from PUF-PAS measurements for SVOCs. Cair was calculated from PUF-PAS measurements from a long-term monitoring program at a site in central Europe applying current understanding of passive sampling theory coupled with a consideration for the sampling of particle associated compounds. Cair were assessed against concurrent active air sampler (AAS) measurements. Use of "site-based/sampler-specific" variables: Rs, calculated using a site calibration, provided similar results for most gas-phase SVOCs to air concentrations derived using "default" values (commonly accepted Rs). Individual monthly PUF-PAS-derived air concentrations for the majority of the target compounds were significantly different (Wilcoxon signed-rank (WSR) test; p < 0.05) to AAS regardless of the input values (site/sampler based or default) used to calculate them. However, annual average PUF-PAS-derived air concentrations were within the same order of magnitude as AAS measurements except for the particle-phase polycyclic aromatic hydrocarbons (PAHs). Underestimation of PUF-derived air concentrations for particle-phase PAHs was attributed to a potential overestimation of the particle infiltration into the PUF-PAS chamber and underestimation of the particle bound fraction of PAHs.

Spatiotemporal patterns and potential sources of polychlorinated biphenyl (PCB) contamination in Scots pine (Pinus sylvestris) needles from Europe.

Using pine needles as a bio-sampler of atmospheric contamination is a relatively cheap and easy method, particularly for remote sites. Therefore, pine needles have been used to monitor a range of semi-volatile contaminants in the air. In the present study, pine needles were used to monitor polychlorinated biphenyls (PCBs) in the air at sites with different land use types in Sweden (SW), Czech Republic (CZ), and Slovakia (SK). Spatiotemporal patterns in levels and congener profiles were investigated. Multivariate analysis was used to aid source identification. A comparison was also made between the profile of indicator PCBs (ind-PCBs-PCBs 28, 52, 101, 138, 153, and 180) in pine needles and those in active and passive air samplers. Concentrations in pine needles were 220-5100 ng kg(-1) (∑18PCBs - ind-PCBs and dioxin-like PCBs (dl-PCBs)) and 0.045-1.7 ng toxic equivalent (TEQ) kg(-1) (dry weight (dw)). Thermal sources (e.g., waste incineration) were identified as important sources of PCBs in pine needles. Comparison of profiles in pine needles to active and passive air samplers showed a lesser contribution of lower molecular weight PCBs 28 and 52, as well as a greater contribution of higher molecular weight PCBs (e.g., 180) in pine needles. The dissimilarities in congener profiles were attributed to faster degradation of lower chlorinated congeners from the leaf surface or metabolism by the plant.

Polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) and metals in scots pine (Pinus sylvestris) needles from Eastern and Northern Europe: Spatiotemporal patterns, and potential sources.

Pine needles were sampled to determine levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and metals in Scots pine (Pinus sylvestris) needles at industrial, urban and background sites in Sweden (SW), Czech Republic (CZ) and Slovakia (SK). Spatial and temporal patterns of PCDD/Fs in pine needles were investigated and principal component analysis (PCA) used to determine spatial patterns, potential sources and transport of PCDD/Fs. Levels of PCDD/Fs in pine needles were generally greatest near to industrial sites (Æ©2,3,7,8-PCDD/Fs (lower bound (LB)): 6 ng kg(-1) - 190 ng kg(-1)) compared to urban and background sites (Æ©2,3,7,8-PCDD/Fs (LB): 0.90 ng kg(-1) - 20 ng kg(-1)). Using metal contamination in pine needles helped to detect spatial patterns and separate local thermal sources of PCDD/Fs.

Source identification, spatio-temporal distribution and ecological risk of persistent organic pollutants in sediments from the upper Danube catchment.

Riverine sediments, collected on a monthly basis during a period of one year, from five sites in a mixed land use region of the Czech Republic were analysed for chlorinated and brominated persistent organic pollutants (POPs). The region is located in the upper catchment of the Danube River. The POPs concentrations were as follows: 11-930 pg g(-1) polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDDs/Fs), 170-980 pg g(-1) dioxin-like polychlorinated biphenyls (dl-PCBs), 34-13,700 pg g(-1) polychlorinated naphthalenes (PCNs), 5.7-29,200 pg g(-1) polybrominated diphenylethers (PBDEs) and 0.21-351 ng g(-1) hexabromocyclododecanes (HBCDs). Concentrations expressed as toxic equivalents (TEQs), for PCDD/F+dl-PCB+PCN (TEQPCDD/F+dl-PCB+PCN) ranged from 0.37 to 19 pg g(-1). The results revealed a clear spatial separation between sites based on concentration and congener profile. There were also some obvious temporal patterns of selected POPs, which were related to river flow (seasonality) and organic carbon (TOC) of the sediment. Potential sources of POPs include local municipalities (flame retardants), some diffuse sources (PCNs and PCDDs/Fs) and potential point sources (PBDEs). Risk assessment based on risk quotients (RQ) revealed limited to medium ecological risk from PBDEs. TEQPCDD/F+dl-PCB+PCN were low relative to other European rivers, hence the risk to aquatic organisms was considered to be low. PCNs contributed significantly to overall TEQ in several cases.

Formation of dioxins during exposure of pesticide formulations to sunlight.

Chlorinated pesticides can contain impurities of dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), and their precursors, as a result of various manufacturing processes and conditions. As precursor formation of PCDD/Fs can also be mediated by ultraviolet light (UV), this study investigated whether PCDD/Fs are formed when currently used pesticides are exposed to natural sunlight. Formulations containing pentachloronitrobenzene (PCNB; n=2) and 2,4-dichlorophenoxyacetic acid (2,4-D; n=1) were exposed to sunlight in quartz tubes, and the concentration of 93 PCDD/F congeners were monitored over time. Considerable formation of PCDD/Fs was observed in both PCNB formulations (by up to 5600%, to a maximum concentration of 57000 µg ∑PCDD/F kg(-1)) as well as the 2,4-D formulation (by 3000%, to 140 µg ∑PCDD/F kg(-1)). TEQ also increased by up to 980%, to a maximum concentration of 28 µg kg(-1) in PCNB, but did not change in the 2,4-D formulation. Assuming similar yields as observed in the present study as a worst case scenario the use of PCNB in Australia may result in the formation of 155 g TEQ annum(-1), contributed primarily by OCDD formation. This warrants detailed evaluations on the contemporary release of PCDD/Fs to the environment after the use of pesticides. Changes in congener profiles (including the ratio of PCDDs to PCDFs (DF ratio)) suggest that pesticide sources of PCDD/Fs after sunlight exposure may not be recognized based on matching source fingerprints established from manufacturing impurities. These changes also provide preliminary insights into the possible formation routes and types of precursors involved.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) impurities in pesticides: a neglected source of contemporary relevance.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) may be formed during the manufacture of chlorinated pesticides, and can remain in the products as impurities. However, the contemporary release of PCDD/Fs to the environment from pesticide use is poorly understood. For this study, 27 pesticide formulations were analyzed for PCDD/Fs (n = 23 registered for use in Australia). PCDD/F impurities were present in all samples, ranging from 0.020 to 2100 ng SigmaPCDD/F g(-1) active ingredient (AI). Among current use pesticides, pentachloronitrobenzene (PCNB) contained the highest impurity levels (up to 2000 ng SigmaPCDD/F g(-1) AI and 5.6 ng TEQ g(-1) AI). The quantity of pesticide used in Australia and associated release of PCDD/Fs was estimated for PCNB and phenoxy herbicides (2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4-dichlorophenoxybutyric acid (2,4-DB)) using a probabilistic approach. Input parameters to model pesticide use contributed the highest proportions to the variability of the estimated PCDD/F release, and were considered to have the highest uncertainty. Preliminary estimates of PCDD/F release suggest that contaminated pesticides represent an important ongoing PCDD/F source to the Australian environment (10th-90th percentiles for PCNB = 14-42 and 2,4-D/2,4-DB = 0.35-1.6 g TEQ annum(-1)). These results may have global relevance given that many of the pesticides analyzed were imported into Australia, and are used in high volumes in other countries.

Assessing dioxin precursors in pesticide formulations and environmental samples as a source of octachlorodibenzo-p-dioxin in soil and sediment.

An as yet unidentified origin of elevated concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) in soil and sediment has repeatedly been described from different locations around the world, including Australia. Natural sources have been hypothesized to account for such contamination, which is characterized by a distinctive dioxin profile, in particular, elevated levels of octachlorodibenzo-p-dioxins (OCDD) as well as relatively low contributions of polychlorinated dibenzofurans (PCDFs). The present study investigated whether OCDD formation via anthropogenically derived precursors represents a possible source in such samples. Soil and sediment from Australia and Hawaii were screened for known pesticide derived dioxin precursors. Two pesticide formulations containing pentachlorophenol (PCP), which are well-known to contain predominantly OCDD impurities, were also analyzed. Polychlorinated phenoxyphenols (PCPPs), common byproducts of pesticide production, were detected at parts-per-billion (ppb) levels in two PCP formulations and in five environmental samples. Of particular interestwasthe presence of the PCPP isomer 3,4,5,6-tetrachloro-2-(2,3,4,5,6-pentachlorophenoxy)phenol (nonaC2PP), often also termed predioxin, in these samples. This compound readily undergoes ring closure to form OCDD under a range of conditions and environments. In addition, the pesticide PCP itself, which also represents a potent precursor to OCDD formation and is known to contain OCDD impurities, was detected in some environmental samples. The evidence from this study indicates that pesticides and their impurities play an important role in the dioxin contamination of Australian soils and sediments, as well as other locations with similar PCDD/F patterns. The results further suggest that formation of OCDD from pesticide derived precursors may be a possible past, present, and future pathway for contamination of environmental samples.